LRSM Events / Burstein 90th Birthday Registration Form

Eli Burstein 90th Registration

REGISTRATION FORM

Name:

Affiliation:

E-mail Address:

Telephone Number:

Address:

Banquet info: YES, I will attend the banquet.
NO, I will not attend the banquet.
number of attendees at $50 per person*

Additional info:

* Banquet payments should be sent by check to the address below and received by September 26th, 2007.

Please make checks payable to:
"The Trustees of the University of Pennsylvania"

and mail to:

LRSM / Burstein 90th
attn. Kathy Kramer
3231 Walnut Street
Philadelphia, PA 19104-6202


The Laboratory for Research on the Structure of Matter University of Pennsylvania / 3231 Walnut Street / Philadelphia, PA 19104-6202, USA tel: 215-898-5425 fax: 215-898-8296 info@lrsm.upenn.edu